Editor’s note: This is the first in a seven-part series that looks at what has changed since The (Whiteville) News Reporter’s series in 2017 that reported on the opioid crisis and associated mental health issues. Today, Reporter Ivey Schofield looks at how opioid misuse became prevalent, how prescription policies have changed, and how heroin has begun to replace harder-to-get opiates like oxycodone. 

By Ivey Schofield

BBI Writer

Two decades ago, Darren Mills finally admitted to himself that he had a problem with drugs and alcohol. He started going to Alcoholics Anonymous and Narcotics Anonymous meetings religiously, but religion, he said, was what the meetings were missing. 

Now, Mills oversees weekly meetings at Western Prong Baptist Church north of Whiteville called Celebrate Recovery, a national program for people who struggle with all habits and hardships, including addiction. 

“It changes people’s lives through God, and that’s the only way you’re going to get lasting change,” Mills said. 

While Mills acknowledges that the NA and AA meetings did help him early in his sobriety, he thinks Celebrate Recovery is a better program. He says that it gets rid of the “once an addict always an addict” label and instead provides people with the opportunity to be born anew. 

That’s why after 22 years of sobriety Mills is helping others find the same freedom and healing he’s encountered through his belief in Christ — and he has no trouble finding people who need help. “In Columbus County, it’s everywhere, it’s bad, and people don’t want to see it,” he said. 

Drug use is Columbus County residents’ biggest health concern, according to a 2019 health assessment from Columbus Regional Healthcare System. 

And it’s only gotten worse since the onset of the pandemic. More people are trying drugs to escape their pain, there are more arrests, more locals are overdosing and more communities are left with gaping holes from the lives lost to substance addiction. 

As a result, many in Columbus County are ready for a change. “It’s like the Catholic Church. We don’t need to do stuff; we need to have a reformation,” said Kevin Ransom, outreach advocate at Families First, the county’s coalition against domestic and sexual violence. 

How did we get here?

For centuries, people have been using the psychotropic properties of opiates to create illusions and manage pain. 

The United States government didn’t get involved until 1914 with the Harrison Narcotic Control Act, which regulated and taxed the production, importation and distribution of opiates and coca products. As a result, drug consumption dropped and remained relatively low for decades. 

But public interest in opiates didn’t disappear. In 1995, the American Pain Society launched a campaign declaring pain to be the fifth vital sign, meaning that physicians needed to consider pain to be as important to health as temperature, blood pressure, respiratory rate and heart rate. 

Not long before, a study with only 38 participants said that the addiction rate of opiates was low. Purdue Pharma took that study and capitalized on it, introducing OxyContin in 1996. 

Over the next five years, oxycodone prescriptions for pain increased from 670,000 to 6.2 million across the United States.

In 2007, Purdue Pharma pleaded guilty to federal charges of misbranding OxyContin, costing the company hundreds of millions of dollars. In 2021, N.C. Attorney General Josh Stein also garnered a $573 million settlement with consulting firm McKinsey & Company for its role in advising manufacturers on their drug promotions. 

Prescription policies

In 2019, Columbus County’s prescribers wrote 76.8 opioid prescriptions per 100 people — which is higher than the state’s rate of 56.7 prescriptions per 100 people and the country’s rate of 46.7 prescriptions per 100 people.

But Columbus County’s opioid prescription rate is improving. In 2017, it had one of the highest rates in the state at 139.8 prescriptions per 100 people.  

In fact, prescription rates are decreasing across the United States. 2020 saw the lowest opioid dispensing rate in 15 years, according to the CDC. 

That’s partly because physicians and pharmacists have changed their policies in response to the prevalence of opioid addiction. Megan Reaves, a pharmacist at McNeill’s Pharmacy in Whiteville, encounters drug misuse almost daily in the county. 

With each patient, Reaves checks a prescription monitoring program, which records any opioid prescription that person has received across the state. She then reports every opioid prescription she dispenses to that program within 24 hours and also works with local doctors to get Narcan for individuals prescribed opioids. 

A few years ago, this wasn’t the case. In 2017, the General Assembly enacted the Strengthen Opioid Misuse Program (STOP) Act that requires the electronic transmission of prescriptions, which prevents patients from filling out their own paper prescriptions and also helps monitor their frequencies. 

There’s also a greater emphasis on pain management through massage, physical therapy and acupuncture. 

Hospital refines opioid protocols

Dr. Evangeline Gonzalez, a hospitalist at Columbus Regional Healthcare System in Whiteville who helped revise the system’s opioid protocols, said that a lack of community resources and in-patient treatment facilities are big issues in Columbus County.

“The community doesn’t have enough resources [to help substance abuse patients],” Gonzalez said. “The ER is not the place for them, but that’s what we’re seeing.”

Staff can provide life-saving acute care and treatment for withdrawal, but the hospital will often hold substance abuse patients for days before an appropriate in-patient care facility can be found to start or continue long-term treatment, Gonzalez said. 

This takes an inordinate amount of resources, she said, which is particularly troublesome during high patient census times like those seen during the pandemic.

Gonzalez said an emphasis on changing procedures and protocols for local providers has made a difference in decreasing opioid prescriptions. 

“We knew we had a problem,” she said. 

Educating providers, better pain management treatment protocols that involve prescribing fewer opioids, and a new digital record-keeping system that allows providers and ER doctors to track opioid use have contributed to the decrease, Gonzalez said. The state now requires physicians to take continuing education classes on prescribing opioids before they renew their licenses annually.

Additionally, patients who are prescribed opioids by CRHS providers are required to sign a contract that educates them about opioid misuse and the consequences. Violating the contract can include withholding future prescriptions. 

The digital record-keeping system allows physicians to see if patients have already been prescribed opioids by other physicians, which diminishes the issue of “doctor shopping.”

“You’re not relying on what the patient tells you,” Gonzalez said. “You can see their prescriptions on their record.”

The switch to heroin

As a result of these stricter prescription practices — along with the high cost of maintaining a pill habit — many ultimately turn to the cheaper, more accessible, faster-acting heroin. 

For example, a person gets in a car accident and receives a prescription for oxycodone to help manage the pain. After a while, the person’s brain becomes accustomed — and starts to crave — that high from the drug. 

What happens, though, when the opioid prescription ends?

The brain screams for the next high. Then there are the withdrawal symptoms that can feel debilitating— body aches, fast heartbeats and fevers that quickly turns into vomiting and even hallucinations.

That’s why some turn to heroin. 

But heroin is much less safe than a prescribed pill. Dirty and shared needles can lead to HIV and hepatitis C infections, and heroin is often laced with fentanyl, which is around 100 times more potent than morphine. 

As a result, people are taking their usual doses of heroin but dying because they’re unaware of fentanyl’s potent presence in the mixture. 

In Columbus County, unintentional deaths due to overdoses increased from 17.2 deaths in 2017 to 28.8 deaths in 2020 per 100,000 residents — or by 67%. 

“It’s an epidemic, and it’s destroying a lot of good people in the county,” said Ricky Bullard, chair of the Columbus County Board of Commissioners. 

Need for long-term solutions

That’s why Bullard is asking for public involvement, and he is not the only one in Columbus County interested in finding solutions to the drug epidemic. 

The Columbus County Partnership for Children, an organization that supports childhood development from birth to 5 years old, is working with faith-based organizations, establishing parenting cafes and getting financial support from county and state legislators.

The key is knowing that the county, and the country, has a problem with drug use. “I don’t know how long it’s going to take to win, but it’s a battle worth fighting,” said Selena Rowell, director of Columbus County Partnership for Children.

Darren Mills admitted to himself that he had a problem. Now, he helps others do the same every Monday night at Celebrate Recovery. Together, they raise their hands and sing, “Oh God, the battle belongs to you.”

BBI Publisher Les High contributed to this story.